Irregular Periods

During a woman’s reproductive years, a normal menstrual cycle usually lasts anywhere from 21 to 35 days, with approximately seven to eight days of bleeding, and usually expelling approximately two to three ounces of blood. For the majority of women, the color of the blood or the amount of bleeding is not as important as how regular her menstrual periods are and whether there is any bleeding between periods. Menstruation is the time of month when the womb (uterus) sheds its lining and vaginal bleeding occurs. Periods vary widely from woman to woman. Some periods are punctual, some are unpredictable. On average, a woman gets her period every 21 to 35 days. A period usually lasts about three to five days. Irregular periods may require treatment.

Irregular Periods

To have an irregular cycle means that the interval between periods varies each month. That is, sometimes they come every 28 days, sometimes every 20, sometimes every 30.

Having irregular periods is very common. The causes can range from something insignificant to something that requires treatment. For example, if a girl is in her teen, her body’s hormones can fluctuate and take some time until they find a balance. Therefore, it’s normal to have an irregular period during adolescence or, sometimes, for the period not to arrive in a given month.

Women may have irregular periods if –

Periods that occur less than 21 days or more than 35 days apart.

Missing three or more periods in a row.

Menstrual flow that is much heavier or lighter than usual.

Periods that last longer than seven days.

Periods that is accompanied by pain, cramping, nausea, or vomiting.

Bleeding or spotting that happens between periods, after menopause, or following sex.

Types of irregular Periods

Amenorrhea is a condition in which a woman’s periods have stopped completely. The absence of a period for 90 days or more is considered abnormal unless a woman is pregnant, breastfeeding, or going through menopause (which generally occurs for women between ages 45 and 55). Young women who haven’t started menstruating by age 15 or 16 or within three years after their breasts begin to develop are also considered to have amenorrhea.

Oligomenorrhea refers to periods that occur infrequently.

Dysmenorrhea refers to painful periods and severe menstrual cramps. Some discomfort during the cycle is normal for most women.

Abnormal uterine bleeding may apply to a variety of menstrual irregularities, including: a heavier menstrual flow; a period that lasts longer than seven days; or bleeding or spotting between periods, after sex, or after menopause.

Causes

Age – During the first few years after menstruation starts, periods are often irregular while the hormones that control menstruation reach a balance. They may also be irregular at the end of menstrual years when women reach perimenopause and menopause – menopause starts when it’s been 12 months since a menstrual period.

Those irregularities are normal and common. But there are other times in women’s lives and other conditions that can lead to irregular menstrual cycles.

Pregnancy – The most common cause of a missed period is pregnancy. Until the woman knows for sure if she is pregnant or not, she should treat herself as though she is. This is one instance when she should be called OB/GYN or midwife. she can use an at-home pregnancy test, but the healthcare provider can use other tests to determine whether she is pregnant.

PCOS is a hormone imbalance that can affect ovulation, cause issues with a woman’s period and make it more difficult to get pregnant. If the doctor determines this is the cause of the irregular periods, treatment may include birth control pills or other hormones to restore hormonal balance.

Hypothyroidism, a.k.a. underactive thyroid disease, is caused by the thyroid gland not producing enough of its hormone. Similar to PCOS, treating hypothyroidism involves supplementation of thyroid hormones.

Other medical conditions include-

Uterine polyps or fibroids – Uterine polyps are small benign (noncancerous) growths in the lining of the uterus. Uterine fibroids are tumors that attach to the wall of the uterus. There may be one or several fibroids that range from as small as an apple seed to the size of a grapefruit. These tumors are usually benign, but they may cause heavy bleeding and pain during periods. If the fibroids are large, they might put pressure on the bladder or rectum, causing discomfort.

Endometriosis – The endometrial tissue that lines the uterus breaks down every month and is discharged with the menstrual flow. Endometriosis occurs when the endometrial tissue starts to grow outside the uterus. Often, the endometrial tissue attaches itself to the ovaries or fallopian tubes; it sometimes grows on the intestines or other organs in the lower digestive tract and in the area between your rectum and uterus. Endometriosis may cause abnormal bleeding, cramps or pain before and during periods, and painful intercourse.

Pelvic inflammatory disease. Pelvic inflammatory disease (PID) is a bacterial infection that affects the female reproductive system. Bacteria may enter the vagina via sexual contact and then spread to the uterus and upper genital tract. Bacteria might also enter the reproductive tract via gynecologic procedures or through childbirth, miscarriage, or abortion. Symptoms of PID include a heavy vaginal discharge with an unpleasant odor, irregular periods, pain in the pelvic and lower abdominal areas, fever, nausea, vomiting, or diarrhea.

Premature ovarian insufficiency – This condition occurs in women under age 40 whose ovaries do not function normally. The menstrual cycle stops, similar to menopause. This can occur in patients who are being treated for cancer with chemotherapy and radiation, or if you have a family history of premature ovarian insufficiency or certain chromosomal abnormalities.

Uterine cancer or cervical cancer.

Medications, such as steroids or anticoagulant drugs (blood thinners).

Medical conditions, such as bleeding disorders, an under- or pituitary disorders that affect hormonal balance.

Complications associated with pregnancy, including miscarriage or an ectopic pregnancy (the fertilized egg is implanted outside the uterus; for example, within the fallopian tube).

Lifestyle Conditions

Excessive weight loss or gain – Although low body weight is a common cause of missed or irregular periods, obesity also can cause menstrual problems

Eating disorders, such as anorexia or bulimia

Increased exercise – Missed periods are common in endurance athletes.

Emotional stress

Medicines such as birth control methods, which may cause lighter, less frequent, more frequent, or skipped periods or no periods at all

Hormone problems – this may cause a change in the levels of the hormones that the body needs to support menstruation

Illegal drug use

Problems with the pelvic organs , such as imperforate hymen, polycystic ovary syndrome, or Asherman’s syndrome

Breastfeeding – Many women do not resume regular periods until they have completed breastfeeding.

Complications

Anemia – Menorrhagia (heavy menstrual bleeding) is the most common cause of anemia (reduction in red blood cells) in premenopausal women. A blood loss of more than 80mL (around 3 tablespoons) per menstrual cycle can eventually lead to anemia. Most cases of anemia are mild. Nevertheless, even mild-to-moderate anemia can reduce oxygen transport in the blood, causing symptoms such as fatigue, lightheadedness, and pale skin. Severe anemia that is not treated can lead to heart problems.

Osteoporosis – Amenorrhea (absent or irregular menstrual periods) caused by reduced estrogen levels is linked to osteopenia (loss of bone density) and osteoporosis (more severe bone loss that increases fracture risk). Because bone growth is at its peak in adolescence and young adulthood, losing bone density at that time is very dangerous and early diagnosis and treatment is essential for long-term health. Osteoporosis is a condition characterized by progressive loss of bone density, thinning of bone tissue, and increased vulnerability to fractures.

Infertility – Some conditions associated with heavy bleeding, such as ovulation abnormalities, fibroids, or endometriosis, can contribute to infertility. Many conditions that cause amenorrhea, such as ovulation abnormalities and polycystic ovary syndrome, can also cause infertility. Irregular periods from any cause may make it more difficult to conceive. Sometimes treating the underlying condition can restore fertility. In other cases, specific fertility treatments that use assisted reproductive technologies may be needed.

Quality of Life – Menstrual disorders, particularly pain and heavy bleeding, can affect school and work productivity and social activities.

Treatment

The treatment of abnormal menstruation depends on the underlying cause:

Regulation of the menstrual cycle – Hormones such as estrogen or progestin might be prescribed to help control heavy bleeding.

Pain control – Mild to moderate pain or cramps might be lessened by taking an over-the-counter pain reliever, such as ibuprofen or acetaminophen. Aspirin is not recommended because it might cause heavier bleeding. Taking a warm bath or shower or using a heating pad might help to relieve cramps.

Uterine fibroids – These can be treated medically and/or surgically. Initially, most fibroids that are causing mild symptoms can be treated with over-the-counter pain relievers. If a woman experience heavy bleeding, an iron supplement might be helpful in preventing or treating anemia. Low-dose birth control pills or progestin injections (Depo-Provera) may help to control heavy bleeding caused by fibroids. Drugs called gonadotropin-releasing hormone agonists may be used to shrink the size of the fibroids and control heavy bleeding. These drugs reduce the body’s production of estrogen and stop menstruation for a while. If fibroids do not respond to medication, there are a variety of surgical options that can remove them or lessen their size and symptoms. The type of procedure will depend on the size, type, and location of the fibroids. A myomectomy is the simple removal of a fibroid. In severe cases where the fibroids are large or cause heavy bleeding or pain, a hysterectomy might be necessary. During a hysterectomy, the fibroids are removed along with the uterus. Other options include uterine artery embolization, which cuts off the blood supply to the active fibroid tissue.

Endometriosis – Although there is no cure for endometriosis, over-the-counter or prescription pain relievers may help to lessen the discomfort. Hormone treatments such as birth control pills may help prevent overgrowth of uterine tissue and reduce the amount of blood loss during periods. In more severe cases, a gonadotropin-releasing hormone agonist or progestin may be used to temporarily stop menstrual periods. In severe cases, surgery may be necessary to remove excess endometrial tissue growing in the pelvis or abdomen. A hysterectomy might be required as a last resort if the uterus has been severely damaged.

Alternative treatment

Multivitamin and Mineral – A good quality multivitamin and mineral would form the foundation of the supplement programme to make sure that the body is getting a ‘little bit of everything’.

Vitamin B – These are often called the ‘stress’ vitamins because they can help to cope with the pressures of everyday life. As stress can be such an important factor in causing irregular periods it is important that you have some help in dealing with it. Vitamins B2, B3 and B6 are also necessary for thyroid hormone production and B5 (pantothenic acid) is essential for optimum adrenal function. Both imbalances in thyroid function and stress can affect the cycle.

The easiest way to make sure that the body is getting a good supply of these vitamins is to take them in the form of a good B-complex tablet. B vitamins are synergistic, which means that they work together.

Antioxidants – Antioxidants are particularly relevant with irregular periods. It is believed that antioxidants have the ability to prevent cells from mutating. In other words, they prevent cells from becoming ‘abnormal’. This is extremely important if a woman has been diagnosed with thickening of the womb lining (endometrial hyperplasia) because she does not want the cells to mutate. Antioxidants include vitamins A, C and E and the mineral selenium. Their effects have been proven – women with womb tumours have been shown to have less of both selenium and vitamin E than women without them so make sure that the body is getting enough of these valuable nutrients.

Magnesium – This mineral has been classed as ‘nature’s tranquilliser’, so it is an essential inclusion in the diet of anyone suffering from irregular periods. In fact, anyone in today’s hectic society will benefit from a magnesium supplement. Stress is often a factor in period irregularity, and this mineral will help to redress the balance of a stressful lifestyle.

Omega 3 Fatty Acids – Flaxseeds (linseeds), which are an excellent source Omega-3 fatty acids, have been shown to encourage regularity of the cycle. Even if hormonal imbalance is not at the root of the problem, it is worth adding these fatty acids to the diet. There are many factors that are now known to affect the way fatty acids are used by the bodies, including high adrenaline levels (in the case of stress), high alcohol consumption, and high levels of cholesterol.

Herbs and Supplements – Generally, manufacturers of herbal remedies and dietary supplements do not need approval from the Food and Drug Administration to sell their products. Just like with drugs, herbs and supplements can affect the body’s chemistry, and therefore have the potential to produce side effects that may be harmful.

Black cohosh (also known as Cimicifuga racemosa or squawroot) contains a plant estrogen and is the most studied herbal remedy for treating menopausal symptoms, including dysmenorrhea, although most studies have indicated it is ineffective. Headaches and gastrointestinal problems are common side effects. It should not be taken for more than 6 months.

Ginger tea or capsules may help to relieve nausea and bloating.

Magnesium supplements may be helpful for relieving dysmenorrhea. Some women also report benefit with vitamin B1 (thiamine) supplements.

Aromatherapy with topically-applied lavender, sage, and rose oils may help ease menstrual cramps, according to some small studies.

Pycnogenol, an extract from the bark of the French maritime pine tree, may help reduce menstrual pain and discomfort, according to some small studies.

Acupuncture and Acupressure:Some studies have reported relief from pelvic pain after acupuncture or acupressure, a technique that applies small pins or pressure to specific points on the body. More research is needed.

Yoga and Meditation:Yoga and meditative techniques that promote relaxation may help relieve menstrual cramps.

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